Due to low diagnosis rates of hepatitis C virus (HCV) infections worldwide, most countries are running out of patients to treat, according to data released November 1 at the World Hepatitis Summit in Sao Paulo, Brazil.
“Hepatitis C is a silent killer and there are nearly 70 million people worldwide who need treatment, but we must find them,” said Charles Gore, president of the World Hepatitis Alliance. “Yet, because of the historic lack of national and international investment in viral hepatitis programs, the vast majority of patients with hepatitis C—some 80%—remain undiagnosed, and less than 5% are able to access treatment.”
The data, released by the Center for Disease Analysis (CDA) Foundation’s Polaris Observatory, in Lafayette, CO, show that new diagnoses of HCV must triple from 1.5 million to 4.5 million each year and treatment rates increase from 1.76 million to 5 million to achieve the World Health Organization’s (WHO) goal of eliminating viral hepatitis as a major public health threat by 2030.
Worldwide, only one in five patients (14 million of 69 million) with chronic HCV know of their infection. That rate varies from 44% in high-income nations to 9% in low-income countries.
“We have the right to know if we are living with a cancer-causing virus,” said Raquel Peck, chief executive officer of the World Hepatitis Alliance. “In addition to the need for people to be diagnosed to access treatment, a high proportion of the 1.5 million new hepatitis C infections last year could have been avoided if people were aware of their health status.”
A record 3 million people were able to obtain treatment for HCV during the past 2 years. However, only nine countries—Australia, Brazil, Egypt, Georgia, Germany, Iceland, Japan, the Netherlands, and Qatar—are currently on course to meet WHO’s goal of eliminating the virus by 2030.
“We have seen a nearly five-fold increase in the number of countries developing national plans to eliminate life-threatening viral hepatitis over the last 5 years,” said Gottfried Hirnschall, MD, MPH, director of WHO's Department of HIV and Global Hepatitis Programme. “These results bring hope that the elimination of hepatitis can and will become a reality.”
A number of countries are using innovative strategies to improve their diagnosis rates, from testing at dental appointments and in hospital emergency rooms to screening entire villages to offering financial incentives. Some were highlighted at the World Hepatitis Summit for their innovative work to eliminate the virus.
For instance, Egypt pledged to test 30 million people for hepatitis C by the end of 2018 by implementing mass screening (with assistance from the military), as well as mass producing generic copies of direct-acting antiviral (DAA) drugs for less than $200 (US) per 12-week course.
The Australian government provided universal access to DAAs with a $1 billion (AUS) investment over 5 years. In a risk-sharing agreement with pharmaceutical companies, the government funded treatment for all adults. In 2016, more than 30,000 Australians with hepatitis C were treated and cured.
“What we are seeing is that some countries, especially those with a high burden, are making the elimination of viral hepatitis a priority and are looking at innovative ways to do it,” said Homie Razavi, PhD, MBA, managing director of the CDA Foundation. “However, it will be near-impossible for most other countries to meet the WHO targets without a huge scale-up in political will and access to diagnostics and treatment.
“Only with a combination of political will, increased access to diagnostics, and greater awareness of the disease can we vastly improve diagnosis rates,” Dr. Razavi said. “Unless we crack this diagnosis challenge, the ambitious elimination targets for hepatitis set by WHO will remain out of reach for decades to come.”